Demand for state health services rise when economy sinks

Among other things, the new law requires that health care programs like Medi-Cal will not only have to expand the health services they provide but that those expanded services be made available to a more diverse population. The federal government then reimburses states like California for most of the costs of implementing the changes required by the law.

But the question of whether or not California can seize those federal funds rests in part on the state’s ability to fund initial improvements to the Medi-Cal system within the next two years before most of the federal requirements take effect.

For example, the Affordable Care Act requires that Medi-Cal be made available to all individuals within 133 percent of the federal poverty line — about $14,500 income for an individual — regardless of whether or not they have children or are disabled. That would add an estimated 2 million people to the Medi-Cal rolls, according to the non-partisan legislative analyst.

California managed to implement this provision ahead of time by requiring counties to provide health services for this particular population. As a result, the state negotiated an agreement with the federal government that should bring an additional $10 billion to California, paid out over the next ten years.

But the federal call for expansion is at odds with the statewide call for frugality. The state deficit is $26.6 billion, which equals about a third of the $84.6 billion general fund.

Legislators have approved roughly $1.6 billion in cuts to Medi-Cal.

As a result, Medi-Cal recipients will be expected to pay co-payments for hospital and routine doctor’s visits and prescription drugs. They will also face limitations on how many times they can visit a doctor in a year. Doctors, hospitals and clinics that serve Medi-Cal recipients will see a 10 percent decrease in their reimbursement rate.

Medi-Cal funding affects programs administered by state departments outside of the Department of Health Care Services. It directly funds services, such as In-Home Supportive Services, primary and acute care, and it provides funding for programs operated by other departments, including the Departments of Aging, Developmental Services, and Mental Health.

Because the money is used for so many different programs, the effects of budget cuts are diverse and far-reaching. Not surprisingly, so is the public outcry.

Assemblywoman Mitchell estimates that at least one thousand people came to her sub-committee to testify against proposed cuts during eight hearings spread over two weeks.

“With Medi-Cal, it was a very diverse group,” Mitchell said. “One particularly poignant witness was a woman who was disabled at the hands of her ex-husband ... she suffered multiple strokes and we she used a motorized wheelchair ... these motorized wheelchairs are very heavy and they burn through batteries. With some of these cuts, she won’t be able to get those batteries she needs for her wheelchair.”

Cuts like these could jeopardize the state’s ability to snag federal healh reform dollars, according to Anthony Wright, Executive Director of Health Access, a statewide health advocacy organization.